World Journal of Plastic Surgery最新文献

Background: We aimed to create focus and awareness about versality of keystone flap in safe re-surfacing of small to medium and large sized skin defects in single stage with minimal donor site morbidities and maximum anatomical, functional and aesthetic results.

Methods: Retrospective study was conducted between October 2021- December 2022 on 26 males and 5 females aged 20-70 years who underwent 32 Keystone flap reconstruction (type IIA n=11, type IIB n=7 type III n=6, Type IV n=8) in diversity of defects following: domestic electric burn on pulp of thumb (n=2), chronic discharging sinus over clavicle (n=1), post-traumatic wounds on eighteen legs (n=19), excision of unstable scar over shin of tibia (n=4), exit wound on medial aspect of foot (n=3) and excision of non-healing ulcer over heel (n=3). Flaps were designed in a way to keep maximum perforators in pedicular area and to ascertain maximum mobility. After debridement, wound area ranged from 4mm x 4mm to 17 x 8 cm. The flap size ranged from 5mm x 5mm to 18cm x 8cm. Follow- ups ranged from 1 month to 12 months.

Results: Three cases developed partial wound dehiscence which were managed subsequently. None of the flap had partial or total loss. Over-all results were satisfying.

Conclusion: Our series highlighted that keystone flaps have defect adaptive design and are technically easy to perform, cost and time effective and can be designed from head to toe (omnipresence) with excellent outcome. We advocate their use as robust reconstructive tool for Plastic surgeons, Orthopedic surgeons and Dermatosurgeon.

Background: Hypertrophic scars (HTS) and keloids are the proliferative responses of the fibroblastic. Surgical excision lead to changes, but postoperative recurrence rate seems to be still high. The topical use of mitomycin C (MMC) has been thus documented to suppress fibroblast proliferation. We aimed to investigate the effects of MMC injection on HTS and keloids in burn wounds, and compare the results with intralesional Triamcinolone Acetonide (TAC) injection in with regard to scar size reduction.

Methods: This randomized clinical trial was conducted on 90 burn patients (divided into two groups) with hypertrophic scars and keloids at Taleghani Burn Hospital, Ahvaz, Iran, in 2023. Patients were randomly assigned to receive intralesional MMC (0.4 mg/dL) or TAC (0.4 mg/dL). Scar characteristics were assessed pre- and post-treatment using the Vancouver Scar Scale (VSS) over six months.

Results: The average size of the scars at the pre- and post-intervention stages was 15.71 and 4.81 mm. No significant difference was observed between both groups. Effect of MMC was over and above TAC. There was a significant difference between both groups. Significant difference was found between the Vancouver Scar Scale (VSS) mean scores before and after the intervention, so the TAC value was greater than that of MMC, and the scores at the pre- and post-intervention stages were significantly different.

Conclusion: MMC and TAC were considered as effective methods for HTS and keloid management. In spite of this, the VSS scores and the scar size denoted that MMC was much more effective in the treatment of such scars than TAC.

Background: Diabetes mellitus is related to wound healing process impairments and molecular abnormalities of the wound. We aimed to evaluate the therapeutic potential of semi-solid bone marrow as a source of stem cells (SCs) in regenerative medicine.

Methods: This trial study was conducted at the Faculty of Medicine, Lorestan University of Medical Sciences, Khorram Abad, IRAN in 2019. Forty five Albino Wistar rats with an average weight of 250-300g, were purchased from Lorestan Aftabavaran Company in (Khorramabad, Lorestan, Iran). The rats were divided into 3 groups (n=15). For all groups, Streptozotocin (STZ) (Single dosage; 65 mg/kg, i.p.) was used to induce diabetes, and Sharp dissection was used to draw and pull down a dorsal skin flap (9×3 cm) in the control and saline groups on day0, respectively. The group used 7 × 10⁹ BMMSCs on day 0. Histologic specimens were stained with hematoxylin and eosin and were stained with trichrome mason. Biomechanic measurements were taken in the wound area.

Results: The epidermal thickness was increasing and blood vessels were growing. In the cells group, hair follicle destruction, cellular penetration, diffuse fibrosis, and necrosis were not observed in comparison with the saline and control groups. The Cells group had a higher energy absorption than the Bending stiffness and Maximal Force Ultimate Tensile Strength (UTS) group on day 14 as a result of decreased Bending stiffness and Maximal Force Ultimate Tensile Strength (UTS).

Conclusion: According on result of recent study, Stem cells can improve the healing of diabetic incision wounds.

Background: One of the most important stages in rhinoplasty is the control of nasal tip rotation. Different techniques have been proposed to achieve this goal. We aimed to compare the effects of two methods of Septocolumellar Suture (SCS) and Lateral Crural Overlay (LCO) on nasal tip rotation by measuring of Columella-Labial angle.

Methods: In a single-blinded clinical trial, 148 patients were selected among the patients who were candidates for rhinoplasty in Sina Hospital in Tehran, Iran 2024. The patients were randomly divided into two groups (each group contained 74 subjects). The patients in the first group were operated on using LCO technique, and the patients in the second group were operated on using SCS technique. Columella-Labial angle of the samples were evaluated using the photographs of the samples before and six months after surgery. The obtained results were compared using SPSS software and t-paired and Mann-Whitney statistical tests.

Results: The mean Columella-Labial angle in both groups was more than that before surgery (P<0.001). The mean Columella-Labial angle before surgery in the SCS group were higher than that in LCO group and this difference was significant (P<0.001). The Columella-Labial angle difference was also significant between the two groups after surgery (P = 0.005), and Columella-Labial angle in LCO group was higher than that in SCS group (P <0.001).

Conclusion: LCO technique increase Columella-Labial angle more than SCS technique. Therefore, it is recommended that LCO technique to be used in patients with who need greater Columella-Labial angle change.

Background: Abdominoplasty surgery is associated with intra-abdominal pressure (IAP) and respiratory airway pressure (RAP) changes. We aimed to assess the impact of the lipoabdominoplasty on the simultaneous changes in the IAP and RAP and their predictive factors for the first time.

Methods: This prospective study was conducted on 30 women who underwent lipoabdominoplasty between November 2021 and November 2022 in Modares and 15- Khordad hospitals affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran. Patients underwent lipoabdominoplasty by a surgeon with more than ten years of experience. RAP was measured based on P platue and P Peak three times (after anesthesia, after plication, and after surgery).

Results: The mean changes of IAP and RAP were significantly different based on the p peak and p plateau after anesthesia, plication, and surgery (P<0.001). Changes in IAP with BMI, degree of laxity, degree of plication, number of pregnancies, xiphoid to pubis distance, and 12th vertebra to ASIS distance were related. RAP (p peak and P platue) with a degree of laxity, degree of plication, number of pregnancies, IAP, xiphoid to pubis distance, and 12th vertebra to ASIS distance were related (P<0.05).

Conclusion: lipoabdominoplasty significantly affects changes in IAP and RAP after anesthesia, plication, and surgery. During lipoabdominoplasty, surgeons should simultaneously pay attention to the changes in both IAP and RAP from the beginning to the end of the surgery, especially in obese women with a history of multiple pregnancies and patients with severe laxity.

Background: Extensor tendon repair is prone to adhesion that affects the outcomes of tendon repair surgery and tendon function regain. Prevention of these complications should be considered in tendon rupture treatment. We aimed to evaluate the effect of tendon wrapping with amniotic membrane on the outcomes of extensor tendon repair in zone 6.

Methods: This randomized controlled clinical trial was conducted on 30 patients with an extensor tendon injury in zone 6 following penetrating trauma to extensor digitorum communis of the third and fourth digits referred to 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran . Patients were randomly assigned into two matched groups based on age and gender. Both groups underwent tendon repair using the modified Kessler method. In the intervention group (n=15), the repair site was wrapped with an amniotic membrane, while the control group underwent the traditional procedure without wrapping. Both groups underwent a similar rehabilitation process. Patients were followed up for 6 months. The QuickDash score, range of motion (ROM), complications, and recovery duration were recorded for patients in both groups.

Results: The patients in the intervention group had a lower QuickDash score (P<0.001), ROM (P<0.001), and shorter recovery duration (P<0.001) compared to the control group. The only complication was a wound infection that was seen in one patient in the control group. There was no evidence of tendon re-rupture and amniotic membrane hypersensitivity among patients.

Conclusion: Amniotic, wrapping is an effective method in extensor tendon repair and is associated with better outcomes and faster recovery, suggesting less peritendinous fibrosis.

Background: Melasma, characterized by irregular skin hyperpigmentation, presents a therapeutic challenge with limited universal solutions. Platelet-rich plasma (PRP) and Tranexamic Acid (TXA), coupled with microneedling, offer promising avenues for treatment. This clinical trial sought to compare the efficacy and adverse effects of microneedling with PRP versus TXA in managing melasma.

Methods: The study was a single-blind, randomized controlled trial from May 2022 to Apr 2023 and enrolled 23 female melasma patients. Using the coin toss method, patients were randomly assigned to receive microneedling with PRP on one side and microneedling with TXA on the other. Evaluation parameters included Melasma Area and Severity Index (MASI) scores, melasma improvement grading, patient satisfaction, and treatment-related side effects, monitored over three sessions at 3-week intervals.

Results: Both microneedling approaches demonstrated effectiveness, with the PRP group exhibiting significantly lower MASI scores at the 6th and 9th wk. However, no significant distinctions were observed in improvement grading or patient satisfaction between the PRP and TXA groups. Side effects were minimal, limited to transient burning and mild pain during the procedure.

Conclusion: Microneedling with PRP and TXA emerged as a safe and effective treatment for melasma. While the PRP group showed potential superiority in MASI scores, comprehensive considerations, including patient preferences and long-term outcomes, are crucial. Larger, multi-center studies with extended follow-up periods are warranted for a more nuanced understanding of these treatments in melasma management.

Syndactyly is a common inherited and clinically heterogeneous malformation which can be syndromic or non-syndromic. It also varies phenotypically between the families. In this study, we present twins who experienced bilateral syndactyly and underwent reconstruction using the Gilbert method. These female twin toddlers were referred to Hazrat Fatemeh Clinic of Hand Surgery in Tehran, Iran, in 2022 with bilateral syndactyly of the middle and ring fingers. In both, fingers were fused along their entire length. One of them underwent the separation of the middle finger and ring finger of the right hand by the Jibert method, and the other underwent surgery for the separation of her left hand at the age of one and a half. She was presented with a contracture of the middle finger and third web space, corrected with a Z-plasty of the middle finger and the V-M flap for the web space.

Background: Retrorectal tumors are rare, heterogeneous neoplasms in the pararectal space that have low incidence, nonspecific symptoms, and variable presentations; they are often challenging to diagnose and manage, necessitating high clinical suspicion. We evaluated the clinical characteristics, diagnostic challenges, surgical outcomes, and postoperative follow-up of patients with retrorectal tumors treated over 12 years.

Methods: A retrospective case series was conducted on 34 patients who underwent surgery for retrorectal tumors at Taleghani Hospital, Tehran, Iran, from 2011 to 2023. Clinical presentations, imaging findings, surgical interventions, histopathological diagnoses, and postoperative outcomes were analyzed.

Results: Thirty-four patients with 37 lesions were included, with a mean age of 40.21 ± 11.57 years. The majority of patients were female (88.2%). Pelvic pain was the most common symptom (44.1%), followed by rectal pain (38.2%). The retrorectal space was the most frequently affected location (67.6%). Most tumors were cystic (51.4%), with congenital tumors being the most common histopathological subtype (37.8%). Malignancy was identified in 29.7% of cases. The most frequent surgical approach was total resection via the posterior approach (55.9%), followed by the anterior approach (26.5%). Postoperative recurrence requiring secondary surgery was observed in 5.9% of patients.

Conclusion: Due to their rarity and diverse presentations, retrorectal tumors pose significant diagnostic and surgical challenges. Preoperative imaging plays a critical role in diagnosis and surgical planning. Complete surgical excision remains the mainstay of treatment, and recurrence is rare. Multidisciplinary collaboration is essential for optimizing patient outcomes.

Background: Alveolar osteitis (AO), commonly known as dry socket, is a recognized complication following tooth extraction, particularly prevalent after mandibular third molar extractions. Given the global pandemic of coronavirus disease (COVID-19) and its implications for endothelial and hematologic changes, investigating its potential impact on dry socket risk in patients undergoing mandibular third molar extraction is crucial.

Methods: We reviewed patient records from individuals undergoing mandibular third molar extraction at Mashhad Dental School, Mashhad, Iran in 2022. Data included demographics, medical history, smoking status, and COVID-19 details such as history, hospitalization, and vaccination status.

Results: Clinical examinations diagnosed alveolar osteitis, assessing for blood clot presence and local lymphadenitis. Out of 119 patients (82 females, 37 males), 49.6% developed dry socket post-extraction, with 94.1% having a history of COVID-19 and 32.7% requiring hospitalization due to the disease. 97.5% of patients were vaccinated against COVID-19. Additionally, 44.5% had systemic disease history, and 45.4% used related medications, with no observed associations with dry socket.

Conclusion: This study underscores the increased risk of dry socket following mandibular third molar extraction associated with corticosteroid use, oral contraceptive use, smoking, and COVID-19 hospitalization. Females exhibited a significantly higher risk compared to males. While no significant COVID-19 infection-dry socket link was found, the study highlights the need for further research, given the significant number of dry socket cases among COVID-19 patients and those hospitalized due to COVID-19.